I cannot pass up the opportunity to point out this wonderful quote by Ginia Ballafante in her NY Times piece, Fear of Vaccines Goes Viral. The article starts by noting an article on plummeting vaccination rates in Los Angeles:

The piece had the virtue of offering New Yorkers yet another opportunity to feel smugly superior to their counterparts in L.A., because of course here on the East Coast we like our science to come from scientists, not from former Playboy models and people who feel entitled to pontificate about public health because they drink kefir.

As a scientist who works in New York, I can’t help but think that this is not entirely true. This idea is supported by a quote in the article from a New York City pediatrician, who says that 10 percent of parents in his practice express opposition to vaccination. If they oppose vaccination, they can’t be getting their information from scientists.

Here is the second best quote from the article, which comes from another New York City pediatrician after a discussion of current Ebola virus and enterovirus D68 outbreaks:

My feeling is that it will take something like that on a very large scale to get upper-middle-class people to realize that this is serious stuff…most of the deaths in the world are from contagious diseases. Not ISIS.

We petition President Obama to amend Executive Order 12333, adding a paragraph after the prohibition on covert action related to US domestic politics. The amendment should ban persons in the intelligence community or acting on their behalf from joining or participating in any activity directly related to the provision of child public health services.

India has been free of polio for over one year. This is a remarkable accomplishment, considering that just 30 years ago the country recorded 200,000 cases of the disease annually, or one every three minutes. With polio endemic in two neighboring countries, Pakistan and Afghanistan, and in the more distant Nigeria (figure), can India remain free of the disease? According to Shahnaz Wazir Ali, the Pakistani Prime Minister’s focal person for polio, there is little risk for export of the virus from Pakistan:

The likeliness of polio virus being exported to India from Pakistan is very low, and historically, it has not happened. Those who travel from India to Pakistan are mostly adults. There are rarely any babies. So the chances are low.

It is correct that polio has not traveled from Pakistan to India during the modern era of virus detection (1980 to the present). However, the same genotypes of types 1 and 3 poliovirus have circulated in both countries, implying sharing of viruses some time in recent history. Therefore Ali cannot conclude that export of virus to India ‘has not happened’.

Poliovirus continues to circulate in Pakistan, which shares a border with India: there were 198 cases in that country in 2011, the most of any in the world, and 16 cases so far in 2012. Remember that most poliovirus infections are asymptomatic, so the number of paralytic cases is far lower than the actual number of infections. The ratio of paralytic cases to infections varies according to the viral serotype: 1:200, 1:1800, and 1:1200 for types 1, 2, and 3 respectively. Furthermore, poliovirus has been known to spread from Pakistan from other countries. An outbreak of polio in Xinjiang, China, in 2011 was caused by virus imported from Sindh, Pakistan. There were 21 paralytic cases caused by poliovirus type 1, over half of which occurred in individuals 19-53 years old. The outbreak was halted by immunization but the region remains at risk for importation from Pakistan.

Poliovirus also continues to circulate in Afghanistan, which lies on the northwestern border of Pakistan. Eighty cases of paralytic disease were reported in this country in 2011, and 7 so far in 2012. It has been difficult to control polio in the southern provinces of Kandahar and Helmand due to ongoing armed activities. There is active migration between the southern regions of Afghanistan and Pakistan which has lead to a steady exchange of polioviruses between the two countries.

There many other examples of polio spread from one country to another in recent years. Following cessation of polio immunization in 2003, virus spread from Nigeria to many countries in Africa as well as to Indonesia. From India poliovirus has spread to Nepal, Angola (2005 and 2007), and Tajikistan and then to Russia (2010), in all cases causing substantial outbreaks of the disease.

The message is clear: poliovirus spreads easily among countries, and it is often spread by infected adults, not children. Because poliovirus infection is frequently asymptomatic, such spread cannot be detected by simply examining travelers for signs of paralysis.

For these reasons I am skeptical of Ali’s reassurance that the virus is not likely to spread from Pakistan to India. If adults mainly travel from India to Pakistan, as she says, they could well be infected and import the virus back home before it is detected. Furthermore, adults could bring the virus to India from other countries where poliovirus continues to circulate, although that is not Pakistan’s concern.

Because Pakistan remains a major reservoir of poliovirus, it is a good sign that the country is acknowledging the possibility that they might export the virus to India. The best way to avoid this scenario would be to intensify their immunization programs and eliminate the virus. Apparently Ali has been speaking with Indian officials to learn how they accomplished this goal:

We got to know what actually took India to become polio-free. We have understood the scale and efforts that we require to make Pakistan polio-free.

All the evidence I’ve seen so far points to a poor uptake of the influenza 2009 H1N1 vaccine in the United States. This is not good news – inadequate immunization means more infections and more deaths.

A few weeks ago I asked a class of about 50 students in a course on Emerging Infections whether they would receive the 2009 influenza H1N1 vaccine. None of them raised their hands. Yesterday, I taught seven high school biology classes about viruses; I asked each group (about 30 students) if they were going to get immunized. About 5 out of over 200 students said they would.

My informal poll may not be indicative of the mood of the entire nation, but there is no doubt that the vaccine is in trouble. You would have to be living in a cave to realize that fear about the 2009 H1N1 vaccine is being propagated by the press and various blogs and websites. Incorrect information from people who know little about viruses, viral vaccines, or infectious disease is easy to find. The following email from a Microbiology Professor in Portugal illustrates the problem:

It is impressive the amount of hate emails on H1N1 vaccines. With all this hate email, people are starting to ask if they should take the vaccines or not. I just hope it doesn’t spread to other vaccines. I’ve heard from a few health related workers that they won’t take the vaccines because they have doubts about their safety. The worst thing is, that most of the times the reason for that, is just an email they have recieved.

As you can see from the image above, even in non-pandemic years, the number of people who receive influenza vaccine in the US is low. The CDC estimated that the overall rate in the 2008-09 season was 32.6%. The number varies according to age and ethnicity, but the best immunization rate – 67% – is in those over 65 years of age. When the vaccine is a good match with the circulating strain – which happens to be the case with the 2009 H1N1 strain – the vaccine is 70-80% efficacious. But it’s not helpful at all if only a third of the general population is immunized.

I’ve already received my seasonal influenza vaccine and I’m waiting for the 2009 H1N1 vaccine to become available. My entire family – including my three children – will receive both vaccines. Is there any better endorsement for the vaccine? If you don’t believe me, read Paul Offit’s words on why the vaccine is safe and efficacious.

Please let me know whether or not you are going to receive the 2009 H1N1 vaccine – and your reasons for shunning it – by posting a comment.

Here at Columbia University Medical Center, all employees and students may receive, at no charge, influenza vaccine every year. I just went to the lobby of the Milstein Hospital, showed my ID, and received the seasonal influenza vaccine. Here is the proof:

As I’ve written before, vaccine records provide interesting information. The medical center administration has clearly printed many of these slips to accommodate those who will be receiving the pandemic H1N1 vaccine in a few weeks. Below ‘Seasonal Influenza Vaccine’, which is checked, is ‘H1N1 Vaccine #1 DOSE’. They have left open the possibility that more than one dose will be required, despite a published study – using CSL vaccine – that one dose induces protective immunity.

The nurse who administered the vaccine placed a small sticker on the record, which indicates that the preparation that I received, Afluria®, was manufactured by CSL Biotherapies, an Australian company and a recent (2007) entrant into the US influenza vaccine market. Using a sticker obviously allows the medical center to purchase vaccine from different suppliers. I’ll be interested to know the supplier of the pandemic H1N1 vaccine.

The vaccine that I received is trivalent. It contains three different seasonal influenza virus strains: A/Brisbane/59/2007 (H1N1); A/Brisbane/10/2007 (H3N2); B/Brisbane/60/2008. The viral strains were propagated in embryonated hen eggs, inactivated with formalin, and disrupted with detergent.

The nurse who administered the vaccine asked me the following questions: “Do you have allergies to eggs or latex; are you taking coumadin; do you have a history of Guillain-Barré (which she mispronounced), do you have a fever”? She also told me to put ice on the inoculation site if it became sore, that “all the antibodies I was going to develop would appear in 2-3 weeks”, and that any flu-like symptoms that result will last for a day or two.

While I waited, three other employees lined up for their immunizations. And they were giving out lollipops or tootsie rolls.

The Centers for Disease Control and Prevention (CDC) would like to know what the public feels about the impending H1N1 influenza vaccination program this fall. The agency plans to conduct ten meetings in different parts of the United States to learn if the public would like a massive vaccination campaign, or a reduced effort.

The meetings will take place throughout August in Colorado, Nebraska, Alabama, California, Indiana, Texas, Pennsylvania, Massachusetts, Washington, and New York. You must make an online reservation to attend one of these meetings.

Do you think this is a good idea? Does the CDC care what the public thinks about what the size of the vaccine campaign should be, or is this a tactic to calm down a confused and concerned public? I’m interested in learning what the readers of virology blog think about these ‘Public Engagement Meetings’. Add a comment below, or send it to virology@virology.ws.